Why is my fasting sugar high in the morning

It is completely natural to think that your blood sugar should be lower after a night sleep. After all, you have not eaten anything for many hours. But the body needs glucose 24 hours a day, and if you are not getting it from food, your body will turn to stored glucose in the liver. Your pancreas needs to make insulin to deal with this glucose, just as it does for glucose derived from the food you eat. Unfortunately, in many people with diabetes, insulin production during periods of fasting is as bad as or even worse than during eating. Therefore, the sugar may rise overnight because glucose being produced by the liver is not matched by adequate insulin from the pancreas. Certain medications, including glyburide (brand name Micronase or DiaBeta), glipizide (brand name Glipizide) and glimepiride (brand name Amaryl), improve meal-related insulin production more than fasting insulin production. As a result, many people who take these medicines have higher glucose levels in the morning than before bed at night.
Sometimes a snack at bedtime with protein, some healthy fat and a slowly absorbed carbohydrate, such as two teaspoons of peanut butter on a half-slice of stone-ground whole-wheat bread, may actually lower the morning glucose because it prevents you from entering a fasting state while sleeping. If this does not work, using a long-acting form of insulin as part of the treatment is usually very effective.

Table of Contents Show

This isn’t Dawn Phenomenon
Feet on the floor
How to prevent high morning blood sugar
How can I lower my fasting morning blood sugar?
What causes high fasting blood sugar?

You wake up. Lay in bed for a few minutes before getting up. Check your blood sugar. 115 (6.3 mmol/L) stares back at you.

You smile to yourself: life is good.

Forty minutes later, when you sit down to eat, your blood sugar meter or CGM tells you that you are now at 180 (10 mmol/L)! You have eaten NOTHING. All you’ve done is prepare for the day and prepare food. Now you face the grim potential of chasing your high blood sugars all day long.

What is going on??

Let me explain why your blood sugar sometimes can be high in the morning and what you can do about it

This isn’t Dawn Phenomenon

Many people would blame this rise in blood sugar on dawn phenomenon (DP), which has a similar endpoint, but a different mechanism. Dawn phenomenon is the result of hormones releasing in the body in the early morning – predominantly growth hormone, cortisol, epinephrine, and glucagon – which in turn increase insulin resistance. The current basal insulin from the pump or long-acting injections is no longer enough, and blood sugars rise.

That hormonal surge happens around 2 am-6 am, with most of it occurring in the middle of the night. Let’s say you woke up at 7:30 am and aren’t in the “DP zone.” It’s not DP. Then what?

Feet on the floor

The moment your feet touch the floor as you roll out of bed, you signal to your body, “Hey, I need energy for all the stuff I’m about to do!” Your body recognizes you haven’t eaten in many hours. Your body is also lazy smart and wants the most easily accessible source of energy: the liver.

The liver is the Wal-Mart for stored energy since it’s got everything you need. It stores glycogen that can be easily broken down when fasted or needed for activity, AND is the home of gluconeogenesis, a process where protein is broken down to glucose for energy.

Guess what? You’re fasted AND about to move, which is activity. So, your liver decides to dump glucose into the bloodstream. It will also break down some protein to glucose, but to a much lesser extent.

The cells take up the glucose as much as they can, but you may still be insulin resistant from the night before and from the cortisol dump that occurs each day around 7 am (hence why you may need a greater amount of insulin at breakfast than other meals. Food for thought.)

BAM! Blood glucose levels begin to rise similarly to an amusement park ride – it starts gradually and suddenly gets quicker and quicker. Those of you with CGM may see this.

How to prevent high morning blood sugar

Do not fret, friends. There are ways to deal. Here are three simple ways:

1) Take insulin right when you wake up

If it’s 2 pm and you notice your blood sugar is shooting up for no apparent reason, you’d take a correction dose of insulin to prevent that spike, right? (Well, I’d hope so).

The same concept applies here.

To determine how much insulin to take, wake up, record blood sugar values at 30 and 60-minute intervals, and record this for a few days (or use CGM data if you have it). Then, you can use your insulin to carb ratio to determine a correction bolus.

2) Increase your basal rate around your wake up time

If you fight Dawn Phenomenon, what’s a common strategy for success? Increasing basal rates in the wee hours of the morning to counteract that hormone-induced spike.

Well, if you’re used to a particular morning routine and know it’ll take you a little while to prepare food and eat, consider increasing that basal rate during that time period. That additional insulin may overcome the liver dumping glucose and blunt your blood sugar spike, or ideally, prevent it in the first place.

3) If you skip breakfast, stop skipping it and EAT SOMETHING

As a registered dietitian, I can regurgitate all the information from the Academy of Nutrition and Dietetics about why breakfast is important. This isn’t about that, but in all honesty here, try eating SOMETHING. I’d love if it were healthy, but if you’re just DYING to have Cinnamon Toast Crunch, by all means, have at it. If you’re about the low-carb life, go for some eggs.

This should, feasibly, prevent an even further increase in blood sugar had you not eaten anything at all and just went about your day.

Pop Quiz: What do these have in common?

If you answered insulin administration, you win!

Insulin, through more biochemistry magic, shuts off the liver glucose output, whether it comes from glycogen breakdown or gluconeogenesis. Thus, the spike should be halted in its tracks. YAY!

Bonus: Just add water!

Let’s pretend you decide to make some Gatorade from powder. It says to add 1 cup of water and mix thoroughly, so you do. You taste it, and it’s WAY too strong and concentrated. You add more water, mix, and now it’s delicious.

SAME THING WITH YOUR BODY.

You wake up in a state of dehydration because you haven’t consumed fluids in hours. Thus, the sugar in your circulation is more concentrated. Even if you wake up to a nice blood sugar, it’s quite possible the liver dump can have an even more accelerated effect because of this, so drinking a glass of water early (or even in bed) may help with this too.

(Also, most people don’t drink enough water each day, so it’s an easy way to sneak some more in)

These strategies should help you get your morning off to a better start, combat those pesky high morning blood sugars, and not allow diabetes to interfere with your plans!

How can I lower my fasting morning blood sugar?

How can high blood sugar levels in the morning be controlled?.

Changing the timing or type of your diabetes medications..

Eating a lighter breakfast..

Increasing your morning dose of diabetes medication..

If you take insulin, switching to an insulin pump and programming it to release additional insulin in the morning..

What causes high fasting blood sugar?

Food-related factors that can trigger significant rises include : eating large meals. consuming sugary foods and drinks. eating foods with simple carbohydrates, or carbs, such as bread and sweet snacks.